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Employer liable for out-of-network medical costs


SAN FRANCISCO—Employers or their insurers are liable for injured employees' out-of-network medical costs when they neglect to inform employees about their rights under California's medical provider network system, according to a ruling released Thursday.

The en banc opinion by the California Workers' Compensation Appeals Board in Bruce Knight vs. United Parcel Service and Liberty Mutual Insurance Co. upholds the findings of a workers compensation administrative law judge.

The case involved Mr. Wright, a UPS worker, who injured his right wrist, arm and shoulder when he slipped and fell while delivering a parcel in February 2005, the opinion states.

He eventually designated sought treatment from his own treating physician while neither Mr. Wright nor his attorney received notice of UPS' medical provider network for more than two months after the accident, according to the opinion.

Under workers comp reforms adopted in California in 2004, employers or their insurers were allowed to establish state-approved medical provider networks and direct employees to receive care under the networks. Employers or their insurers, however, must properly notify employees about their use of a network, where and how to receive treatment, notice of their right to be treated by a network doctor of their choice after the first visit, options for a second opinion, and other information.

UPS in this case argued that it provided "appropriate notice of information," the opinion states. But the appeals panel disagreed.

"We hold that an employer or insurer's failure to provide required notice to an employee of rights under the (medical provider network) that results in a neglect or refusal to provide reasonable medical treatment renders the employer or insurer liable for reasonable medical treatment self-procured by the employee," the panel found.